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Stephen Turner is a home-based withdrawal nurse at YSAS Bendigo. In 2009 a young man came to see him who had been using cannabis and dabbling in chroming. Stephen sat in front of him with a sheet of paper divided into two columns – one side to list the bad aspects of his drug use, the other to list the good.

Hearing this, the young man smiled in surprise. “No one’s ever asked me what’s good about it,” he said.

Stephen’s background is in psychiatric nursing, and he says this ‘decisional balancing’ exercise is important because substance dependency nearly always has something to do with mental health. “A lot of young people are using a substance to self-medicate a psychological problem,” he explains. When asked about their drug use, one common response is “It helps me forget”. In this context, it can be unrealistic to ask young people to give up a substance that has played a positive role as a coping mechanism, without first supporting them to build up resilience and psychological wellbeing.

It was a similar story with this young man – drug use helped him to forget trauma in his past. The exercise with the double-sided ledger started him thinking about the coping role drugs played in his life so he could identify what he might struggle with if he tried to give up. It also helped pinpoint positive aspects of substance use that might need to be replaced by other activities.